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Medicina
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Effects of Abdominal Hysterectomy on Gynecological Patients
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Effects of Abdominal Hysterectomy on Gynecological Patients

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Obstetrics and Gynecology".

Deadline for manuscript submissions: closed (20 March 2024) | Viewed by 17293

Special Issue Editors

Dr. Vito Andrea Capozzi

E-Mail Website
Guest Editor
Azienda Ospedaliero - Universitaria di Parma, Parma, Italy
Interests: endometrial cancer; ovarian cancer; borderline ovarian tumors; surgery; laparoscopy
Dr. Stefano Cianci

E-Mail Website
Guest Editor
Department of Obstetrics and Gynecology, University of Messina, 98122 Messina, Italy
Interests: hysterectomy; ovarian cancer; gynecologic oncology; gynaecological surgery; laparoscopic surgery; ovary; cancer prevention; cancer care facilities
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Hysterectomy is one of the most frequently performed surgical procedures worldwide. Hysterectomy can be performed for benign disease, oncology, or hemodynamic instability in emergency cases of metrorrhagia. Over the years, several concerns have arisen about patients’ quality of life, pelvic stability, vascular, ureteral, and bowel complications after hysterectomy. However, hysterectomy remains a necessary treatment in case of gynecological oncological pathology, or life-saving treatment in case of emergency.

This Special Issue aims to review the role of hysterectomy in various gynecological diseases. Furthermore, the different laparotomic, laparoscopic, and robotic surgical approaches will be reviewed and the latest technologies for performing hysterectomy will be investigated.

We are inviting original articles, systematic reviews, and meta-analyses to this issue.

Dr. Vito Andrea Capozzi
Dr. Stefano Cianci 
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • gynecologic disease
  • hysterectomy
  • surgery
  • endometrial cancer
  • ovarian cancer

Related Special Issue

Published Papers (8 papers)

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Research

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9 pages, 307 KiB  
Article
Rate of Vaginal Cuff Dehiscence When Using Vicryl (Poliglactyn 910) Compared to PDS (Polydioxanone) for Vaginal Cuff Closure in Laparoscopic Hysterectomy
by Francesco Giuseppe Cannone, Livia Cormaci, Carla Ettore, Ferdinando Antonio Gulino, Giosuè Giordano Incognito, Domenico Benvenuto and Giuseppe Ettore
Medicina 2024, 60(1), 90; https://doi.org/10.3390/medicina60010090 - 03 Jan 2024
Cited by 1 | Viewed by 1083
Abstract
Objective: To compare the vaginal cuff dehiscence (VCD) rates using Vicryl (Poliglactyn 910) and Polydioxanone (PDS) in patients who underwent laparoscopic hysterectomy. Materials and methods: A retrospective, monocentric study was conducted, including all patients undergoing laparoscopic hysterectomy at the Department of Obstetrics and [...] Read more.
Objective: To compare the vaginal cuff dehiscence (VCD) rates using Vicryl (Poliglactyn 910) and Polydioxanone (PDS) in patients who underwent laparoscopic hysterectomy. Materials and methods: A retrospective, monocentric study was conducted, including all patients undergoing laparoscopic hysterectomy at the Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, Catania, between January 2014 and December 2021. Patients underwent hysterectomy for benign gynecologic pathologies (endometriosis, leiomyomas, or benign pelvic pathologies) or malignant gynecologic pathologies (endometrium cancer, complex endometrial hyperplasia, ovarian cancer, cervix cancer, or uterine carcinosarcoma). The Z-score calculation was performed to find eventual statistically significant differences between the two populations regarding VCD rates. Results: Laparoscopic vaginal cuff closure was performed, with Vicryl sutures in 202 patients and PDS sutures in 184 women. Demographic and baseline characteristics were not significantly different in the two groups. VCD occurred in three patients in the Vicryl group and did not occur in the PDS group. The three cases of VCD were precipitated by intercourses that occurred within 90 days of surgery. However, there was not a significant statistical difference between the two groups regarding VCD (p = 0.09). Conclusions: Vicryl and PDS sutures seem to be similar for vaginal cuff closure in laparoscopic hysterectomy. The VCD rate was low, and the observed differences between the Vicryl and PDS groups did not reach statistical significance. Further research through prospective studies is essential. Full article
(This article belongs to the Special Issue Effects of Abdominal Hysterectomy on Gynecological Patients)
15 pages, 371 KiB  
Article
Urologic Complication after Laparoscopic Hysterectomy in Gynecology Oncology: A Single-Center Analysis and Narrative Review of the Literature
by Vito Andrea Capozzi, Luciano Monfardini, Elisa Scarpelli, Giuseppe Barresi, Isabella Rotondella, Alessandra De Finis, Davide Scebba, Giuseppe Maglietta, Stefano Cianci, Tullio Ghi and Roberto Berretta
Medicina 2022, 58(12), 1869; https://doi.org/10.3390/medicina58121869 - 18 Dec 2022
Cited by 6 | Viewed by 2546
Abstract
Background and Objectives: Minimally invasive surgery (MIS) has recently increased its application in the treatment of gynecological malignancies. Despite technological and surgical advances, urologic complications (UC) are still the main concern in gynecology surgery. Current literature reports a wide range of urinary tract [...] Read more.
Background and Objectives: Minimally invasive surgery (MIS) has recently increased its application in the treatment of gynecological malignancies. Despite technological and surgical advances, urologic complications (UC) are still the main concern in gynecology surgery. Current literature reports a wide range of urinary tract injuries, and consistent scientific evidence is still lacking or dated. This study aims to report a large single-center experience of urinary complications during laparoscopic hysterectomy for gynecologic oncologic disease. Materials and Methods: All patients who underwent laparoscopic hysterectomy for gynecologic malignancy at the Department of Medicine and Surgery of the University Hospital of Parma from 2017 to 2021 were retrospectively included. Women with endometrial cancer, cervical cancer, ovarian cancer, uterine sarcoma, or borderline ovarian tumors were included. Patients undergoing robotic surgery with incomplete anatomopathological data or patients lost during follow-up were excluded from the analysis. Intraoperative and postoperative UC were analyzed and ranked according to the Clavien-Dindo classification. Results: Two hundred-sixty patients were included in the study: 180 endometrial cancer, 18 cervical cancer, nine ovarian cancer, two uterine sarcomas, and 60 borderline ovarian tumors. Nine (3.5%) UCs were reported (five intraoperative and four postoperative complications). No anamnestic variables showed a statistical correlation with the surgical complication in the univariable analyses. C1 radical hysterectomy, a higher FIGO stage, and postoperative adjuvant treatment (p-value = 0.001, p-value = 0.046, and p-value = 0.046, respectively) were independent risk factors associated with the occurrence of UC. Conclusions: The urological complication rates in patients with oncological disease are relatively rare events in the expert hands of dedicated surgeons. Radical hysterectomy, FIGO stage, and adjuvant treatment are independent factors associated with urinary complications. Full article
(This article belongs to the Special Issue Effects of Abdominal Hysterectomy on Gynecological Patients)

Review

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15 pages, 2004 KiB  
Review
Current Therapeutic Approaches in Cervical Cancer Based on the Stage of the Disease: Is There Room for Improvement?
by Irinel-Gabriel Dicu-Andreescu, Augustin-Marian Marincaș, Victor-Gabriel Ungureanu, Sînziana-Octavia Ionescu, Virgiliu-Mihail Prunoiu, Eugen Brătucu and Laurențiu Simion
Medicina 2023, 59(7), 1229; https://doi.org/10.3390/medicina59071229 - 30 Jun 2023
Cited by 1 | Viewed by 1841
Abstract
Cervical cancer continues to be among the most common malignancies in women, and in recent decades, important measures have been taken to reduce its incidence. The first and most important steps to achieve this goal are oriented toward prevention through screening programs and [...] Read more.
Cervical cancer continues to be among the most common malignancies in women, and in recent decades, important measures have been taken to reduce its incidence. The first and most important steps to achieve this goal are oriented toward prevention through screening programs and vaccination, mainly against oncogenic human papillomavirus (HPV) strains 16 and 18. The therapeutic approach is based on the diagnosis and treatment guidelines for cervical cancer, which establish for each stage (FIGO, TNM) specific conduct. These guidelines summarize quite precisely the elements of therapeutic practice, but, in some places, they leave optional variants based on which nuanced approaches could be established. Adherence to these guidelines, which include the performing of minor or major surgery, with or without chemotherapy and radiation therapy, combined with advanced imaging investigations, has been able to lead to a substantial increase in survival. The purpose of this literature review is to discuss the diagnosis and treatment options in cervical cancer depending on the histological type, FIGO staging, and patient performance index, taking into account the hospital resources available in middle-income countries (percentage of gross domestic product allocated to health services around 5.5%, in the case of Romania). Full article
(This article belongs to the Special Issue Effects of Abdominal Hysterectomy on Gynecological Patients)
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19 pages, 419 KiB  
Review
Post Treatment Sexual Function and Quality of Life of Patients Affected by Cervical Cancer: A Systematic Review
by Stefano Cianci, Mattia Tarascio, Martina Arcieri, Marco La Verde, Canio Martinelli, Vito Andrea Capozzi, Vittorio Palmara, Ferdinando Gulino, Salvatore Gueli Alletti, Giuseppe Caruso, Stefano Restaino, Giuseppe Vizzielli, Carmine Conte, Marco Palumbo and Alfredo Ercoli
Medicina 2023, 59(4), 704; https://doi.org/10.3390/medicina59040704 - 04 Apr 2023
Cited by 4 | Viewed by 2924
Abstract
Introduction: The aim of this study is to analyze the available scientific evidence regarding the quality of life (QoL) and sexual function (SF) in patients affected by cervical cancer (CC) after surgical and adjuvant treatments. Materials and Methods: Preliminary research was [...] Read more.
Introduction: The aim of this study is to analyze the available scientific evidence regarding the quality of life (QoL) and sexual function (SF) in patients affected by cervical cancer (CC) after surgical and adjuvant treatments. Materials and Methods: Preliminary research was conducted via electronic database (MEDLINE, PubMed and Cochrane Library) with the use of a combination of the following keywords: SF, QoL, and CC. The principal findings considered in the present review were the study design, the number of patients included in each study, the information about the malignancy (histology and stage of disease), the questionnaires administered, and the principal findings concerning SF and QoL. Results: All studies were published between 2003–2022. The studies selected consisted of one randomized control study, seven observational studies (three prospective series), and nine case control studies. The scores used were focused on SF, QOL, fatigue, and psychological aspects. All studies reported a decreased SF and QOL. The most developed questionnaires were the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the Female Sexual Function Index (FSFI), the Hospital Anxiety and Depression scale (HADS), and the Female Sexual Distress Scale (FSDS). Discussion: All studies reported a decreased SF and QOL. In addition to the perception of body image, several factors coexist in influencing the outcomes such as the physical, hormonal, psychological. Conclusions: Sexual dysfunction after CC treatment has a multifactorial aetiology which negatively affects the quality of life. For these reasons, it is important to follow and support patients with a multidisciplinary team (doctors, nurses, psychologists, dieticians) before and after therapy. This type of tailored therapeutic approach should become a standard. Women should be informed about possible vaginal changes and menopausal symptoms after surgery and on the positive effects of psychological therapy. Full article
(This article belongs to the Special Issue Effects of Abdominal Hysterectomy on Gynecological Patients)
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11 pages, 327 KiB  
Review
Hereditary Women’s Cancer: Management and Risk-Reducing Surgery
by Carmine Conte, Silvia Pelligra, Giuseppe Sarpietro, Giuseppe Dario Montana, Luigi Della Corte, Giuseppe Bifulco, Canio Martinelli, Alfredo Ercoli, Marco Palumbo and Stefano Cianci
Medicina 2023, 59(2), 300; https://doi.org/10.3390/medicina59020300 - 06 Feb 2023
Cited by 4 | Viewed by 1817
Abstract
Hereditary women’s syndromes due to inherited mutations result in an elevated risk of developing gynecological cancers over the lifetime of affected carriers. The BRCA 1 and 2 mutations, Lynch syndrome (LS), and mutations in rare hereditary syndromes increase this risk and require more [...] Read more.
Hereditary women’s syndromes due to inherited mutations result in an elevated risk of developing gynecological cancers over the lifetime of affected carriers. The BRCA 1 and 2 mutations, Lynch syndrome (LS), and mutations in rare hereditary syndromes increase this risk and require more effective management of these patients based on surveillance and prophylactic surgery. Patients need counseling regarding risk-reducing surgery (RRS) and the time required to perform it, considering the adverse effects of premenopausal surgery and the hormonal effect on quality of life, bone density, sexual activity, and cardiological and vascular diseases. Risk-reducing salpingo-oophorectomy (RRSO) is the gold standard for BRCA-mutated patients. An open question is that of endometrial cancer (EC) risk in patients with BRCA1/2 mutation to justify prophylactic hysterectomy during RRSO surgical procedures. RRS provides a 90–95% risk reduction for ovarian and breast cancer in women who are mutation carriers, but the role of prophylactic hysterectomy is underinvestigated in this setting of patients. In this review, we evaluate the management of the most common hereditary syndromes and the benefits of risk-reducing surgery, particularly exploring the role of prophylactic hysterectomy. Full article
(This article belongs to the Special Issue Effects of Abdominal Hysterectomy on Gynecological Patients)

Other

Jump to: Research, Review

12 pages, 540 KiB  
Systematic Review
Robotic Single-Site Hysterectomy in Gynecologic Benign Pathology: A Systematic Review of the Literature
by Gaetano Riemma, Francesca Pasanisi, Antonella Reino, Maria Cristina Solazzo and Carlo Ronsini
Medicina 2023, 59(2), 411; https://doi.org/10.3390/medicina59020411 - 20 Feb 2023
Cited by 3 | Viewed by 1676
Abstract
Background and objectives: Total hysterectomy is one of the most common gynecologic surgical procedures and it is mainly performed for benign pathologies. The introduction of robotic single-site surgery (RSS) as an acceptable alternative to laparoendoscopic surgery combines the advantages of robotics with the [...] Read more.
Background and objectives: Total hysterectomy is one of the most common gynecologic surgical procedures and it is mainly performed for benign pathologies. The introduction of robotic single-site surgery (RSS) as an acceptable alternative to laparoendoscopic surgery combines the advantages of robotics with the aesthetic result of a single incision. This study aims to review the existing literature on a single-site robotic hysterectomy in patients with benign pathologies and verify its safety and feasibility. Materials and Methods: Following the recommendations in the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement, FP and AR systematically screened the PubMed, Embase, and Scopus databases. No temporal or geographical limitation was discriminatory. Studies containing data about feasibility and safety were included. Results: From 219, only eight studies met the inclusion criteria, and a total of 212 patients were included with a mean patient age of 45.42 years old (range 28–49.5 years old) and a mean BMI of 25.74 kg/m2 (range 22–28.5 kg/m2). The mean presurgical time, including port placement and docking time, was 15.56 (range 3–30) minutes. Mean console time was reported in six studies and is 83.21 min (range 25–180 min). The mean operative time is 136.6 min (range 60–294 min) and the mean blood loss is 43.68 mL (range 15–300 mL). Only two patients in the total analyzed had intraoperative complications and no conversion to LPT occurred. The median hospital stay was 1.71 days (range 0.96–3.5 days). The postoperative complication rate was estimated at 1.4% (vaginal bleeding). Conclusions: Our review supports the safety and feasibility of robotic single-site hysterectomy for benign gynecological diseases. Full article
(This article belongs to the Special Issue Effects of Abdominal Hysterectomy on Gynecological Patients)
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11 pages, 548 KiB  
Systematic Review
Correlations between Gut Microbial Composition, Pathophysiological and Surgical Aspects in Endometriosis: A Review of the Literature
by Irene Iavarone, Pier Francesco Greco, Marco La Verde, Maddalena Morlando, Marco Torella, Pasquale de Franciscis and Carlo Ronsini
Medicina 2023, 59(2), 347; https://doi.org/10.3390/medicina59020347 - 12 Feb 2023
Cited by 13 | Viewed by 2251
Abstract
Background and Objectives: Endometriosis is an estrogen-dependent, inflammatory, gynecological disorder represented by the migration of endometrial tissue outside the uterus. It can manifest through gynecological and gastrointestinal (GI) signs. Given the hormonal imbalances in endometriosis and the effect of microbiota on immune [...] Read more.
Background and Objectives: Endometriosis is an estrogen-dependent, inflammatory, gynecological disorder represented by the migration of endometrial tissue outside the uterus. It can manifest through gynecological and gastrointestinal (GI) signs. Given the hormonal imbalances in endometriosis and the effect of microbiota on immune dysfunction, it has been thought that the human microbiome may play a role in its pathogenesis, acting differently before and after laparotomy. The aim of this review is to establish whether there is an interaction between endometriosis and gut microbial composition. Materials and Methods: We aimed to review available literature by systematically searching five databases: PubMed, EMBASE, Scopus, Cochrane Library, and ScienceDirect. We included records describing gut microbiota in the context of endometriosis—observing PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines—to recognize the presence of disease by the expression of bacterial taxa—based on 16S ribosomal RNA gene sequencing analysis. Results: Among 10 studies selected, there were four review articles and six clinical trials. The latter identified significant differences at a genus level in increased Prevotella, Blautia, and Bifidobacterium and decreased Paraprevotella, Ruminococcus, and Lachnospira (p < 0.05). In patients undergoing abdominal hysterectomy, Proteobacteria phylum increased from 34.36% before surgery to 54.04% after surgery (p < 0.05). Conclusions: Although scientific literature reports different characterizations of intestinal microbiota in endometriotic patients, further evidence is needed to develop new diagnostic-therapeutic strategies, for example, administration with probiotics before surgery. Full article
(This article belongs to the Special Issue Effects of Abdominal Hysterectomy on Gynecological Patients)
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15 pages, 480 KiB  
Systematic Review
Assessment of Salvage Surgery in Persistent Cervical Cancer after Definitive Radiochemotherapy: A Systematic Review
by Carmine Conte, Luigi Della Corte, Silvia Pelligra, Giuseppe Bifulco, Biagio Abate, Gaetano Riemma, Marco Palumbo, Stefano Cianci and Alfredo Ercoli
Medicina 2023, 59(2), 192; https://doi.org/10.3390/medicina59020192 - 18 Jan 2023
Cited by 4 | Viewed by 2193
Abstract
Background and Objectives: The standard treatment approach in locally advanced cervical cancer (LACC) is exclusive concurrent chemoradiation therapy (RTCT). The risk of local residual disease after six months from RTCT is about 20–30%. It is directly related to relapse risk and poor survival, [...] Read more.
Background and Objectives: The standard treatment approach in locally advanced cervical cancer (LACC) is exclusive concurrent chemoradiation therapy (RTCT). The risk of local residual disease after six months from RTCT is about 20–30%. It is directly related to relapse risk and poor survival, such as in patients with recurrent cervical cancer. This systematic review aims to describe studies investigating salvage surgery’s role in persistent/recurrent disease in LACC patients who underwent definitive RTCT. Materials and Methods: Studies were eligible for inclusion when patients had LACC with radiologically suspected or histologically confirmed residual disease after definitive RTCT, diagnosed with post-treatment radiological workup or biopsy. Information on complications after salvage surgery and survival outcomes had to be reported. The methodological quality of the articles was independently assessed by two researchers with the Newcastle–Ottawa scale. Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically searched the PubMed, Scopus, Cochrane, Medline, and Medscape databases in May 2022. We applied no language or geographical restrictions but considered only English studies. We included studies containing data about postoperative complications and survival outcomes. Results: Eleven studies fulfilled the inclusion criteria and all were retrospective observational studies. A total of 601 patients were analyzed concerning the salvage surgery in LACC patients for persistent/recurrent disease after RTCT treatment. Overall, 369 (61.4%) and 232 (38.6%) patients underwent a salvage hysterectomy (extrafascial or radical) and pelvic exenteration (anterior, posterior, or total), respectively. Four hundred and thirty-nine (73%) patients had histologically confirmed the residual disease in the salvage surgical specimen, and 109 patients had positive margins (overall range 0–43% of the patients). The risk of severe (grade ≥ 3) postoperative complications after salvage surgery is 29.8% (range 5–57.5%). After a median follow-up of 38 months, the overall RR was about 32% with an overall death rate of 40% after hysterectomy or pelvic exenteration with or without lymphadenectomy. Conclusions: There is heterogeneity between the studies both in their design and results, therefore the effect of salvage surgery on survival and recurrence cannot be adequately estimated. Future homogeneous studies with an appropriately selected population are needed to analyze the safety and efficacy of salvage hysterectomy or pelvic exenteration in patients with residual tumors after definitive RTCT. Full article
(This article belongs to the Special Issue Effects of Abdominal Hysterectomy on Gynecological Patients)
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